title: A new paradigm for obtaining marketing approval for pediatric-sized prosthetic heart valves.
abstract: OBJECTIVE
  Congenital heart valve disease is one of the most common abnormalities in children. There are limited technological solutions available for treating children with congenital heart valve diseases. The aim of this study is to provide the details of the consensus reached in terms of pediatric definitions, design approach, in vitro testing, and clinical trials, which may be used as guidance for developing prosthetic heart valves for the pediatric indication.
  
  
  METHODS
  In stark contrast to the various designs of adult-sized replacement valves available in the market, there are no Food and Drug Administration (FDA)-approved prosthetic heart valves available for use in the pediatric population. There is a pressing need for FDA-approved pediatric valve devices in the United States. The pediatric patient population has been typically excluded from replacement heart valve trials for several reasons. In January 2010, heart valve manufacturers and pediatric clinicians collaborated with academicians and FDA staff in a workshop to suggest ways to successfully evaluate pediatric prosthetic valves and conduct pediatric clinical trials to provide acceptable heart valve replacement options for this patient population.
  
  
  RESULTS
  Recommendations, derived from ISO 5840:2005 and the 2010 FDA Draft Replacement Heart Valve Guidance, are provided for hydrodynamic, durability, and fatigue testing.
  
  
  CONCLUSIONS
  The article specifically addresses in vitro and premarket and postmarket approval clinical studies that should be considered by a heart valve manufacturer for obtaining regulatory approval of pediatric sizes of prosthetic heart valve designs that are already approved for adult clinical use.
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga. Electronic address: ajit.yoganathan@bme.gatech.edu.
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Yoganathan
authors.forename: Mark
authors.initials: M
authors.lastname: Fogel
authors.forename: Susan
authors.initials: S
authors.lastname: Gamble
authors.forename: Michael
authors.initials: M
authors.lastname: Morton
authors.forename: Paul
authors.initials: P
authors.lastname: Schmidt
authors.forename: Jeff
authors.initials: J
authors.lastname: Secunda
authors.forename: Sara
authors.initials: S
authors.lastname: Vidmar
authors.forename: Pedro
authors.initials: P
authors.lastname: Del Nido
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018795:Device Approval / Q000592:standards; D019544:Equipment Failure Analysis; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000592:standards; D006351:Heart Valves / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008389:Marketing of Health Services / Q000592:standards; D008422:Materials Testing; D017410:Practice Guidelines as Topic; D011358:Product Surveillance, Postmarketing; D011474:Prosthesis Design; D011475:Prosthesis Failure; D014481:United States; D014486:United States Food and Drug Administration / Q000592:standards
keywords: 20; 35; 4.2; AVR; AWT; DFM; EOA; FDA; Food and Drug Administration; HVG; ISO; International Standards Organization; accelerated wear testing; aortic valve replacement; dynamic failure mode; effective orifice area; heart valve guidance